Medical Marijuana: An
Epidemiological Perspective on
Consumption and Consequences
Linda Simoni-Wastila, BSPharm, PhD
University of Maryland School of
Pharmacy
April 13, 2012
Medical Marijuana: Where We’re
Going, Where We Have Been
• Marijuana and medicine
• Marijuana’s benefits and risks
– Health
– Social
• Consumption and consequences of medical
marijuana diffusion
Marijuana: What It Is
• An annual, flowering herb
• Uses:
–
–
–
–
–
Stalk hemp fiber
Seeds health food; “hemp milk”
Flower buds  marijuana
Resin  hashish
Various extracts  hashish oil
• Cannabis plants produce unique family of terpenophenolic compounds (cannabinoids)
– Delta-9-tetrahydrocannabinol (THC)
– Cannabidiol (CBD)
– Many other phenols and flavenoids
Medical Marijuana: Not the new kid
on the block
• 1600s: cultivated in Jamestown for hemp
– 1850, 8000 cannabis plantations
• 1850-1942: included in the United States
Pharmacopeia
• 1913: California law prohibits recreational use
• 1936: all 47 states prohibit recreational use
– 1957: Marijuana Tax Act discontinuation of marijuana
for medicinal use
– 1970: marijuana classified CI drug
• 1996: California passes Compassionate Use Act
• 2012: 17 states + DC have medical marijuana legislation
Marijuana: Medical Uses
• Used primarily for chronic (cancer and non-cancer) pain;
nausea/vomiting; cachexia
• Other recognized uses:
–
–
–
–
–
–
–
–
–
–
HIV/AIDS (wasting/appetite loss)
Glaucoma
Seizure disorders
Crohn’s disease
Arthritis
Multiple sclerosis (muscle spasms)
Muscular dystrophy
Agitation (eg, in Alzheimer’s disease/dementia)
PTSD
Hepatitis C
Medical Marijuana: The Options
• “Au naturale” or synthetic?
– Marinol®: synthetic delta-9-THC
• 2.5mg, 5mg, 10mg capsules in sesame oil
– Cesamet®: synthetic THC
• 1 mg capsule
– Sativex ®: standardized extracts of THC and CBD
• Oromucosal spray
• In Phase III trials in US; approved in many EU countries,
New Zealand, and Canada for MS spasticity and
neurological issues
Medical Marijuana: The Options
• “Natural” cannabis vs Marinol®
– Therapeutic compounds
– Strength/Route of administration
– Psychoactive profile
– Access
– Cost
Health Risks of Marijuana
• Short-term effects:
–
–
–
–
–
–
Distorted perception
Memory/learning problems
Loss of coordination
Impaired cognition/problem-solving
Increased heart rate  4-fold increase in heart attacks
Reduced blood pressure
• Long-term use:
– Anxiety, distrust, paranoia
– At high-doses  hallucinations; delusions; impaired memory; disorientation
– Effects on lungs: cough; acute infections; obstructive disease; cancer?
• Pregnancy risks: neurological impairment
Societal Risks of Medical Marijuana
• Prevalence of all marijuana use may increase
– Encourage recreational use (especially in teens) or
do users come out of the closet?
• Perceived risk of marijuana may decline
• Increase abuse and dependence
– “Gateway” drug  Increase use of “hard” drugs
– Criminal activity 
– Trauma and injury  impaired function in driving
– Treatment  Increased treatment costs
Percent of US Citizens 12 and Older
Reporting Past-Month Marijuana Use
Source: 2010 NSDUH
http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm
Percent of US Citizens Aged 12-17 Who Perceive
Great Risk from Using Marijuana 1-2 Times/Week
Source: 2010 NSDUH
http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm
Prevalence and Perceptions of Risk of
Marijuana—State Level
• Analysis of 13 states with MMLs
– NSDUH 2002-2008
– Adolescents aged 12-17
• 2007-2008:
– Prevalence of past-month marijuana use in states with
MMLs versus states without MMLs
• 8.3%MML vs 6.4%Non-MML
– Perception of marijuana risk in states with MMLs
versus states without MMLs
• 29.5%MML vs 36.2%Non-MML
Wall et al, Annals of Epidemiology, Sept 2011
Marijuana and Traffic Fatalities
• Analysis conducted by Andersen and Rees (11/2011) using
multiple data sources, including Fatality Analysis Reporting
System (FARS), the Behavioral Risk Factor Surveillance
System, and alcohol sales by state
• Found overall traffic fatalities in states with MMLs fell by
9% after MML passage.
• Negative relationship between MML and traffic fatalities
explained by:
– Fatalities involving alcohol reduced by 12%
• Consistent with hypothesis that marijuana and alcohol are substitutes.
• Alcohol consumption 9especially beer) declined in MML states
– Fatalities NOT involving alcohol reduced by 6.4%
• Individuals use marijuana in privacy of home
Source: Anderson and Rees Nov 2011
http://ftp.iza.org/dp6112.pdf
Conclusions
• Will MMLs be successful in achieving their
intended consequence: improving health care
of individuals requiring cannabinoids?
• What unintended consequences may occur
with increased adoption of MMLs?
• Paucity of empiric evidence, and this requires
attention as states move to legislate the use of
marijuana for medical purposes